Bilateral Cochlear Implants If one is good, are two better?

If you have heard of bilateral cochlear implants, you might be curious if having two hearing implants is right for you.

In fact, most cochlear implant (CI) candidates consider getting implants in both ears at some point during the evaluation process.

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Hearing with two ears, known as binaural hearing, has distinct advantages such as improved understanding of speech in noisy settings, as well as better speech recognition and sound localization. In general, hearing “in stereo” with two ears is less strenuous than hearing with one.

Being implanted in both ears with cochlear implants is known as bilateral cochlear implantation, which may provide a person with binaural hearing.

"With my second cochlear implant, I became automatically more communicative with people because I became more confident."

Maurice
An adult bilateral cochlear implant user

Bilateral Cochlear Implants

The Burden of Unilateral Hearing

People who can hear with one ear, such as users of one cochlear implant, usually report good understanding of speech in quiet environments. However, as background noise increases understanding becomes more difficult. It is also hard for them to hear conversations on the impaired side and determine where sounds come from.



The Burdens Adults Face

People who hear with only one ear often report the following:

  • Group conversations are hard to follow
  • Work and social gatherings are challenging
  • More mental effort is needed to listen
  • Exhaustion results from extra listening effort
  • Problems telling where sounds come from
  • Anxiety in noisy places
  • Difficulties when learning and in educational settings

The Burdens Children Face

Children with unilateral hearing are especially affected:

  • They demonstrate significantly poorer understanding when noise is present.1
  • Up to 35% of children with unilateral hearing loss face the potential of underachieving in school.1
  • Infants and toddlers with bilateral cochlear implants tend to have quicker language development than children with only one implant.8

These statistics, when considered along with the ever-changing noise levels in most classrooms, mean that providing the best possible hearing is critical to foster children’s language and academic development.


Whether for children or adults, hearing with two cochlear implants, rather than one, has several important advantages.

Bilateral Cochlear Implants

Hear with Two Ears & Bilateral Cochlear Implants

Considering some of the challenges unilateral users may still face, bilateral implantation can provide a restored ability to localize sounds and the other effects that individuals who can hear with two ears enjoy. 2, 3, 4, 5

The Quality of Hearing
According to 194 Bilateral CI Users6
Before the Second CI

Before the Second CIAverage Rating: 3.23
After the Second CI

After the Second CIAverage Rating: 4.53


After getting a second cochlear implant, some recipients report that they:

  • Feel more ‘balanced’ and connected to their environment because they can hear on both sides.
  • Put less effort into managing difficult environments, for example, by positioning themselves so that their “good ear” is closer to a particular sound source.
  • Experience less fatigue at the end of the day.


Often recipients start by implanting their “bad ear” first. But when the “bad ear” quickly begins to outperform their “good ear”, they begin considering the benefits they could gain from a second implant.

Energy to Hear85.3% of 194 bilateral CI users surveyed say that
“less exhaustion and more energy to hear”
is an important or very important benefit
of having a second CI.6


Benefits reported by bilateral cochlear implant users often include:

  • Better speech understanding in noise
  • Finding it easier to follow group conversations
  • The ability to tell where sounds are coming from
  • Less listening effort and less everyday fatigue
  • Less social isolation
  • Overall improvement in their quality of life


When to Get a Second Cochlear Implant

Often a person receives one cochlear implant and then later decides to get a second. Although it is generally recommended to keep the time between implantations short, there are people who receive their second many years after their first and are happy they decided to do so.

The World’s First Bilateral Cochlear Implant Recipient

Max Roeder was the first child in the world to get bilateral cochlear implants. Discover how two cochlear implants from MED-EL have changed his life by watching this video.

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Children with Bilateral Cochlear Implants

Children with Bilateral Cochlear Implants

Implanted children are a unique group. Unlike adults who may have had hearing before they lost it, children usually learn to listen with only the sound from their cochlear implants.




In a retrospective study from a parent questionnaire, hearing quality in children was found to be significantly better following bilateral implantation.7

Bilaterally implanted children:

  • Respond much faster in group situations
  • React more quickly and appropriately in everyday situations
  • Acquire language spontaneously
  • Require less listening effort to listen
  • Tend to develop language quicker than children with only one cochlear implant.8

According to parents, children also tend to be less tired after school or kindergarten. Parents of bilaterally implanted children often report clear benefits in speech understanding and an increase in their child’s self-confidence.




When Alexandre received his second cochlear implant this improved his hearing abilities immensely, particularly in sound localization and understanding of speech. That shy boy with minimal vocabulary is now today a confident boy with wonderful speech, fully integrated in his social environment.

Deborah
Alexandre’s mother

Closest to Natural Hearing

Closest to Natural Hearing

MED-EL’s “closest to natural hearing” approach makes its cochlear implant systems especially well-suited for bilateral implantation.

MED-EL’s CI electrodes cover the entire cochlea. This provides users closer to natural hearing and significantly better hearing outcomes.9,10 With FineHearing technology, only MED-EL cochlear implants have sound coding that mimics natural time coding for low frequencies. By replicating natural sound coding, FineHearing provides sound quality that is much more natural.

Discover the Difference:
Bilateral Cochlear Implants from MED-EL

Audiologist Jennifer Robinson briefly explains how individuals can benefit from bilateral cochlear implants from MED-EL, which mimic natural hearing and provide the closest to natural sound perception.

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The Next Steps

To get a second cochlear implant:

  • First, your audiologist and clinical team will need to determine if bilateral cochlear implantation is an option for you. If you’d like help finding a cochlear implant audiologist near you, please let us know in the contact form below.
  • If a cochlear implant is the right solution, the next step is implantation. Most surgeons agree that implanting a second device is no different to implanting the first. Candidacy requirements, surgical risks, and potential benefits and limitations of one implant are the same for two implants.
  • About two to four weeks after implantation, the implant can be activated. Your cochlear implant audiologist will program the implant for you and show you how to use everything. This is the first time you will hear with your implants.
  • Daily listening exercises are very important to help maximize benefits. These rehabilitation exercises can be done with a hearing professional or at home. Listening practice can be very beneficial whether you have one implant or two.

Here With You

We understand that hearing loss can be difficult for you and your whole family. That’s why we are committed to supporting you on every step of your journey.

Our dedicated community outreach team members will personally provide step-by-step guidance and answer any questions you have.

We can help you find nearby clinics that specialize in cochlear implants. Our experts can help you navigate questions about insurance coverage and reimbursement. We’ll connect you with cochlear implant recipients and local community events where you can learn more about what everyday life is like with a cochlear implant.

Let us know how we can help you as you take the next steps. Our local support team will get back to you within 24 hours to answer any questions you have. We look forward to hearing from you.

MED-EL - Because We Care

When MED-EL’s founders invented the first modern cochlear implant, their goal was to overcome hearing loss as a barrier to communication and quality of life. Since 1990, MED-EL systems have restored hearing to more than 200,000 individuals worldwide.

Our dedicated support network and local care specialists in over 120 countries ensure our recipients are always well cared for. When you’re ready to take the next step, we’ll be here with you every step of the way.


  1. Tharpe, A. (2008). Unilateral and mild bilateral hearing loss in children: past and current perspectives. Trends in Amplification, 12(1), 7-15.
  2. Nopp, P., Schleich, P., D’Haese, P. (2004). Sound localisation in bilateral users of MED-EL COMBI 40/40+ cochlear implants. Ear and Hearing, 25, 205-214.
  3. Schoen, F., Mueller, J., Helms, J., Nopp, P. (2005). Sound localisation and sensitivity to inter-aural cues in bilateral users of the MED-EL COMBI 40/40+ cochlear implant system. Otology and Neurotology, 26, 429-437.
  4. Senn, P., Kompis, M., Vischer, M., Häusler, R. (2005). Minimum audible angle, just noticeable interaural differences and speech intelligibility with bilateral cochlear implants using clinical speech processors. Audiology and Neurotology, 10, 342-352.
  5. Grantham, D., Ashmead, D., Ricketts, T., Labadie, R., Haynes, D. (2007). Horizontal-plane localisation of noise and speech signals by postlingually deafened adults fitted with bilateral cochlear implants. Ear and Hearing, 28(4), 524-41.
  6. Results from a MED-EL online survey on Bilateral Cochlear Implantation, March-April 2020.
  7. Winkler F et al., The Wurzburg questionnaire for assessing the quality of hearing in CI children (WH-CIK ). J Laryngorhinootologie. 2002 Mar:81(3):211-216.
  8. Long Y, et al., Early auditory skills development in Mandarin speaking children after bilateral cochlear implantation. Int J Pediatr Otorhinolaryngol. 2018 Nov;114:153-158.
  9. Buchman, C.A, Dillon, M.T., King, E.R., Adunka, M.C., Adunka, O.F., & Pillsbury, H.C. (2014) Influence of cochlear implant insertion depth on performance: A prospective randomized trial. Otol Neurotol. 35(10), 1773–1779.
  10. O’Connell, B.P., Hunter, J.B., Haynes, D.S., Holder, J.T., Dedmon, M.M., Noble, J.H., Dawant, B.M., & Wanna, G.B. (2017) Insertion depth impacts speech perception and hearing preservation for lateral wall electrodes. Laryngoscope. 127(10):2352-2357